Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers

• Published in: Journal of primary care & community health Vol. 14; p. 21501319231214513
• Main Authors: Bridges, Kristina M., LeMaster, Joseph W., Parente, Daniel J., Pacheco, Christina M., Schultz, Christine, Morrow, Emily, Corriveau, Erin, Miras Neira, Ton, Greiner, K. Allen, Woodward, Jennifer, Anders- Rumsey, Jordan, Cirotski, Daniel, Finocchario-Kessler, Sarah, Ellerbeck, Edward F.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-01-2023; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Aged; Ambulatory Care Facilities; Barriers; Clinics; Community health care; Community Health Workers; Community resources; Drugs; Health Equity; Health needs; Humans; Indigent care; Interviews; Kansas; Medical personnel; Medical screening; Medicare; Original Research; Physicians, Primary Care; Preventive medicine; Primary care; Primary Health Care; Rural Population; Social Determinants of Health; Social factors; Staffing; United States; United States; Kansas; health equity; social determinants of health; primary care physicians; community health workers; rural; under-resourced
• ISSN: 2150-1319; 2150-1327; 2150-1327
• DOI: 10.1177/21501319231214513

Introduction:
Rural and under-resourced urban communities face unique challenges in addressing patients’ social determinants of health needs (SDoH). Community health workers (CHWs) can support patients experiencing social needs, yet little is known about how rural and under-resourced primary care clinics are screening for SDoH or utilizing CHWs.
Methods:
Interviews were conducted with primary care clinic providers and managers across a geographically large and predominately rural state to assess screening practices for SDoH and related community resources, and perspectives on using CHWs to address SDoH. Interviews were conducted by phone, recorded, and transcribed. Data were analyzed using thematic analysis. We completed interviews with 27 respondents (12 providers and 15 clinic managers) at 26 clinics.
Results:
Twelve (46.1%) clinics had a standardized process for capturing SDoH, but this was primarily limited to Medicare wellness visits. Staffing and time were identified as barriers to proper SDoH screening. Lack of transportation and affordable medication were the most cited SDoH. While respondents were all aware of CHWs, only 8 (30.8%) included a CHW on their care team. Perceived barriers to engaging CHWs included cost, space, and availability of qualified CHWs. Perceived benefits of engaging CHWs in their practice were: assisting patients with navigating resources and programs, relieving clinical staff of non-medical tasks, and bridging language barriers.
Conclusions:
Rural and under-resourced primary care clinics need help in identifying and addressing SDoH. CHWs could play an important part in addressing social needs and promoting preventive care if financial constraints could be addressed and local CHWs could be trained.